This is an informative chapter about disruptive behavior disorders (Attention Deficit/Hyperactivity Disorder). None of this information in here or other chapters can be used to diagnose people. Only psychiatry professions are obligated to diagnose. Psychopathology chapters are review and summary of Textbook “David H. Barlow, V. Mark Durand (2014) Abnormal Psychology: An Integrative Approach” and lecture notes.

Attention Deficit/Hyperactivity Disorder ADHD

• Fail to finish things he or she starts.
• Can't concentrate, pay attention for long.
• Can`t sit still, is restless or hyperactive.
• Daydreams or gets lost in thoughts.
• Acts impulsively without thinking.
• Has difficulty following directions.
• Talks out of turn.
• Does messy work.
• Is inattentive, easily distracted.
• Talks too much.
• Fails to carry assigned tasks.

ADHD Symptoms

1.Symptoms of inattention;

• No attention when spoken
• Cannot follow instructions.
• Difficulty organizing tasks.
• Loses things.
• Easily distracted
• Often forgetful.

2.Symptoms of hyperactivity-impulsivity;

• Fidgets with hands or feet.
• Cannot stay in a classroom.
• Runs around and climbs.
• Talks excessively.
• Answers before questions.
• Cannot wait for the turn.
• Interrupts on others.

3.At least 6 months.
4.Should start before the age of seven.
5.Interfere with the child`s social or academic functioning.

ADHD Epidemiology

• %5 of elementary school children.
• 5-10 times more among boys than girls.
  • More common in firstborn boys.
  • Onset: ~3 years.

Generally not diagnosed until school because diagnosis needs a situation requiring structured behavior patterns.

ADHD long term effects Interfere with academic and social development.

Increased risk of dropping out of school, drug abuse, and criminal behavior.

Not a “delayed development”; 30% - 80 % of children continue to show symptoms of ADHD in adolescence and adulthood.

ADHD Differential Diagnosis

• A temperamental constellation before age 3 is difficult.
• Anxiety.
• Secondary depression.
• Learning disorders.
• Manic episode.

ADHD Explanations

Organic Brain Dysfunction:

Underactivity in the areas of the brain that are responsible for the control of attention and motor activity. Prefrontal cortex and premotor cortex(inhibitory centers).

What causes the brain dysfunction?
• Environmental factors(biological traumas and toxins early in life).
- Infections during the first 12 weeks of pregnancy.
- Anoxia.
- Smoking mothers.
- Ingestion or inhalation of lead.
- Food additives.

• Genetics.
- Monozygotic twins > dizygotic twins.
- Siblings (2:1).

ADHD Treatments

Psychological:

• Teaching the children strategies for controlling their hyperactivity and attention.

Physiological:

Stimulants;

• Methylphenidate (Ritalin).
• Dextroamphetamine (Dexedrine).
  They increase activity in the inhibitory neurons.

Side effects;

• Problems with sleep and appetite.
• Can slow growth in some (drug holidays in weekends and summer).

Case Work

Into Everything:

Eddie, age 9, was referred to a child psychiatrist at the request of his school, because of the difficulties he creates in class.

He has been suspended for a day twice this school year. His teacher complains that he is so restless that his classmates are unable to concentrate. He is hardly ever in his seat, but roams around the class, talking to other children while they are working. When the teacher is able to get him to stay in his seat, he fidgets with his hands and feet and drops things on the floor. He never seems to know what he is going to do next, and may suddenly do something quite outrageous. His most recent suspension was for swinging from the fluorescent light fixture over the blackboard. Because he was unable to climb down again, the class was in an uproar.

His mother says that Eddie's behavior has been difficult since he was a toddler and that as a 3-year-old he was unbearably restless and demanding. He has always required little sleep and been awake before anyone else. When he was small, "he got into everything,'' particularly in the early morning, when he would awaken at 4:30 A.M. or 5:00 A.M. and go downstairs by himself. His parents would awaken to find the living room or kitchen "demolished.'' When he was age 4, he managed to unlock the door of the apartment and wander off into a busy main street, but, fortunately, was rescued from oncoming traffic by a passerby.

He was rejected by a preschool program because of his difficult behavior; eventually, after a very difficult year in kindergarten, he was placed in a special behavioral program for first- and second-graders. He is now in a regular class for most subjects but spends a lot of time in a resource room with a special teacher. When with his own class, he is unable to participate in games because he cannot wait for his turn.

Psychological testing has shown Eddie to be of average ability and his achievements are only slightly below expected level. His attention span is described by the psychologist as ''virtually nonexistent.'' He has no interest in TV and dislikes games or toys that require any concentration or patience. He is not popular with other children and at home prefers to be outdoors, playing with his dog or riding his bike. If he does play with toys, his games are messy and destructive, and his mother cannot get him to keep his things in any order.

Eddie has been treated with a stimulant, methylphenidate, in small doses. While taking the drug, he was much easier to manage at school in that he was less restless and possibly more attentive.

Eddie's behavior graphically demonstrates the characteristic inattention, impulsivity and hyperactivity of Attention-Deficit/Hyperactivity Disorder. He primarily shows symptoms of hyperactivity/impulsivity; he often has difficulty remaining seated, fidgets; runs about or climbs in situations where it is inappropriate and has difficulty waiting his turn.
He also displays some symptoms of inattention; he can't sustain attention, he doesn't seem to listen to what is being said to him and he strongly dislikes activities that require patience and concentration.

The diagnosis of Attention-Deficit/Hyperactivity Disorder requires that some of the characteristic symptoms be present in two or more situations, such as at school and at home, in order to avoid giving the diagnosis to cases in which the disturbed behavior is apparently situation specific.

In this case, it is clear that Eddie's disturbed behavior occurs both at home and at school. The diagnosis also requires that the onset of symptoms be before age 7. In Eddie's case the symptoms apparently began when he was 3.

There are three types of this disorder: Predominantly Attentive, Predominantly Hyperactive-Impulsive and Combined. In this case, the appropriate type would be Predominantly Hyperactive-Impulsive.

Table of Contents

1.Introduction and Historical Issues
Normality and Abnormality in Clinical Psychopathology
2.Diagnostic Systems and Techniques
Interviews, Observations and Tests
3.Anxiety Disorders I
Symptoms of Anxiety, Phobic Disorders, Generalized Anxiety Disorders, Panic Disorder
4.Anxiety Disorders II
Obsessive-Compulsive Disorders, Post-Traumatic and Acute Stress Disorders.
5.Mood Disorders I
Major Depressive Disorder and Dysthymia.
6.Mood Disorders II
Bipolar Disorder and Cyclothymic Disorder.
7.Schizophrenia I
Symptoms and Issues.
8.Schizophrenia II
Explanations and Treatments.
9.Disruptive Behavior Disorders-I
Attention Deficit/Hyperactivity Disorder.
10.Disruptive Behavior Disorders-II
Conduct Disorder and Oppositional Defiant Disorder.
11.Pervasive Development Disorders
Autistic Disorder, Asberger`s and other Developmental Disorders.
12.Elimination Disorders and Tic Disorder.
13.Mental Retardation.
14.Cognitive Disorders
Amnesia Disorders, Dementia Disorders, Delirium Disorders.
15.Suicide.
16.Substance-related disorders.
17.Sexual Dysfunctions.